Heavy periods — when should I worry?

Periods may be considered heavy when the amount of bleeding is interfering with your physical, social or emotional quality of life.

You may notice that you:

• need to change protection very frequently;
• need both pads and tampons together;
• bleed through clothes or bedding;
• pass large clots;
• avoid leaving home or plan activities around your period;
• feel exhausted during or after periods.

If your period dictates what you can wear, where you can go or whether you can work normally, that matters.

If you are unsure what is usual for you in the first place, start with Are my periods normal?.

Sometimes there is no structural abnormality. Possible causes include:

• fibroids;
• adenomyosis;
• uterine polyps;
• problems with ovulation;
• some contraceptive methods;
• hormonal changes approaching menopause;
• less commonly, bleeding disorders or abnormalities of the womb lining.

Your age and other symptoms help determine which possibilities are most relevant.

Yes — and sometimes tiredness is the symptom women notice before they realise just how much blood they are losing.

Repeated heavy bleeding can cause iron deficiency and iron-deficiency anaemia.

You may feel unusually tired, weak, breathless, dizzy or notice palpitations.

A blood count can check for anaemia, and sometimes additional iron studies are useful.

Heavy periods and persistent tiredness are worth mentioning together.

A pelvic ultrasound can help identify conditions such as fibroids and adenomyosis and assess the uterus and ovaries.

Whether you need one depends on your history, examination where appropriate, age and other symptoms.

Sometimes blood tests are more useful initially. Sometimes both are appropriate.

There are several options. Depending on the cause and your circumstances, these may include medicines taken during the period, hormonal treatments or an intrauterine system such as the LNG-IUS. If there is an underlying problem such as a fibroid or polyp, other treatments may be considered. What suits you also depends on whether you need contraception, whether you hope to become pregnant and what treatments you are comfortable with.

Seek urgent medical advice if bleeding is exceptionally heavy and you are feeling faint, dizzy, short of breath, very weak or significantly unwell.

Unusual bleeding associated with pregnancy or possible pregnancy also needs appropriate assessment. And bleeding after menopause should always be investigated.